Photo: Of the AuthorCAMAGÜEY.- In this occasion we dedicate the section to a suffering, of which not for acquaintance, it is known enough, and it is the case of the migraine. In this occasion, and to advise us about its particulars, we have the help of the recognized Dr. José Ángel Infante Ferrer, specialist of 2nd. Grade in Neurology and Intern Medicine, and Teacher Assistant, of the university hospital Manuel Ascunce Domenech, of this city.

-How is it characterized?

- It is a clinical entity with an identification and evolution that dates of many years. In the ancient Greece, it was already known, in the women accompanied on the menstruation.

“It consists of a vascular chronic recurrent headache. With a sharp beginning and on having been already diagnosed one always waits for the recurrence, sometimes in a progressive way, not in other cases. It is necessary to pay attentive, in case of being progressive, we face a picture of alarm, which sometimes is given by the appearance of a new symptom.

“It affects the arteries intra as well as extra-cranial for the reactivity that they have to suffer changes in the elasticity, which leads to be presented in different phases, that is, of contraction or of dilation”.

-Before the pain: does any notice happen?

- Since it does not happen in the unconsciousness state, yes. These notices are determined by the type of migraine that is endured.

-I infer then that its presentation ways are diverse …

- Yes, because they are not all equal. Its classifications are dissimilar. One with aura - transitory neurological symptoms, which are restored of progressive form and provoke alterations in the vision in most of the cases - sometimes accompanied on loss of force of a side of the body, affectations of the visual field as in the retina and vision gets lost or disappears in a fleeting way in one or another eye, depending on the artery that is taken, even, the ophthalmoplegic one and is after there is broken the force of the movement of the eyes with fall of the eyelid, is seen often and is one of the motives of alarm of the population; the persons come to the emergency room and say: "my eye fell down”, and of course, if it does not have a facial palsy or other causes, we have it in one of the forms, before to the pain.

“The hemiplegic migraine is very well described, even, is of familiar origin, hereditary, already with an isolated chromosome. After this happens one thinks about not little occasions in a cerebral infarction, which would be another problem of the central nervous system.

“Other one comes without aura and yes with the pulsatile pain or as if it was a lash, recurrent, which is accompanied or not of visual alterations and of the audition, as there are the photophobia, difficulty to perceive the light and the sounds, aberrations on having received the quality of these, which appear earlier or during the pain and it is the most common, which we name 'simple'.

“If the pain is always on the same side of the head, the doctor has to keep on investigating because the causes can be different, not remain calm”.

Foto: Otilio Rivero Delgado /Adelante

-In the hemiplegic one, does this episode last very much?

- It recovers spontaneously after suffering the pain. It passes in minutes or seconds, before the pain, which comes with the dilation of the blood vessels, or, the filling, not the ischaemic one - that would be before the pain - it is reversible, as it happens with the symptoms of the aura.

-How does the sex influence?

- From three women to a man, although in the childhood the males prevail, in the puberty it is on the contrary and it stays like that during the fertile age.

-Does it prefer any race?

- For the black one, and since to these persons the arterial hypertension affects them more, it is something to be studied, since equal it is stronger, the pain is pulsatile, with nausea and vomiting, which are a similar symptoms and another big cause not related to the migraine within the vascular migraines, and they bring with it the confusion for the signs.

-In the period of the pregnancy: does the woman suffer from migraine?

- Since the estrogen is in recess and increases the progesterone phase, in many they diminish or not suffers it, in others not. We must always bear in mind if the migraine was a début in the gestation state or if the pregnant was already enduring it.

-Do the contraceptive medicines have adverse effects?

- There are a risk for the migraine patients because there increases the surcharge of estrogen and, hence, the crises.

-What is its cause?

- It is multifactorial, sometimes for the ending of allergic disorders or of the serotonin (substance that is present in the neurons and performs neurotransmitter functions), because it suffers from an inflammatory process; in other patients it is triggered due to hormonal alterations as it happens in women in fertile age, up to the neuralgic picture.

“Even the climate, its changes, the excess of heat, the strong smells. All that and more it leads to a discomfort of this nature”.

-And the food?

- Of course, in the same way they trigger the illness, more inside those who untie allergic affectations, like the increase of the serotonin in blood, and it happens with the chocolate, which I believe almost all the women like; the milk and the citrus fruits.

-Does the stress redeem its role in this ailment?

- Also, it intervenes and the proper personalities of everyone are sometimes difficult to handle. The obsessive compulsive one is very awkward of attending, but it is always necessary to try to relieve the persons, the doctor has to manage to remove the crises, diminish the recurrence, this is the principal target”.

-Is it related to poisonous habits?

- Certainly. It is linked to the smoking habit, the alcoholism. The nicotine and the alcohol are conductive substances.

-I have heard that the strong coffee relieves this discomfort: is it true?

- In the ischemic phase not, it is that of contraction and it would close more the blood vessels; nevertheless, it is benefitial to many persons when the pain is installed, already in dilation phase, with the proviso of knowing previously that the person is not with the high blood pressure.

-Some type of prophylaxis?

- Yes, and the specialist indicates it according to the patient and if this one fulfills the orientations, they manage to space the crises out. Those who endure it have to know themselves as any patient with chronic illness, of course, taught by their doctor, and this way adapt themselves to coexist with their problem.

“It is good that the persons note down, do like species of a diary. They should write every day what they eat and the schedules, and nearby to note down yes or not, that is, if the head hurt him or not; if the person is stressed or presents another nervous problem must learn to relax.

“This way he knows what provokes the crisis, if it was the chocolate and even the bean of one or another color; also the absence or excess of sleep. This way he will be able to correct what affects him; of the same way, on having perceived that he will endure it, he should go to a fresh place, as colder, darker and calmer as possible, to avoid for all the means the noises and the clarity”.

-I repeat in these consultations that we leave the medicines for those of private type, between patient and doctor, but: will there be any method that is not pharmaceutical?

- The natural and traditional medicine and the ozone-therapy, both are very affective, and also indicated by the doctor.

-Is there a cure?

- It is a chronic illness; it does not have a cure. In the man, it is more intense and in the woman, it diminishes or is eliminated in the menopause, but not always.

-And that which we heard that it diminishes with the age because the blood flow diminishes likewise: is it true?

- No, what it influences is the change in the hormonal behavior.

-Can it lead to the death?

- No, but it affects the quality of life. In one month, many persons resist between four, five or six crises that last sometimes 42 or 72 hours each one, and there are those who suffer after something that we know as a surf and it is this discomfort sensation after the episode of intense pain. Its duration is variable: from a few hours until several days, therefore it affects the labor and daily life.

The Teacher Infante recounts that of the head many of its parts hurt and inside it are fundamentally, the arteries and the mentioned changes are, while of the extracranial ones the temporary arteries are those which are more damaged and in its trip we find the muscles, the skin, other structures, more internally the meninges, the dura-mater (the most external and resistant of three meninges or membranes that surround the wall of the brain and the spinal cord), which is very painful, and other causes that increase the pressure inside the skull.

After the related thing is necessary to know:

-Is the diagnosis easy?

- No, the headache represents a headache for the doctor, especially on having made debut because the doctor must discard the signs of alarm like the inflammation of the optical nerves, which would lead then to the eye fund, of not being like that, there is more calmness. Always to come to the safety of which there are no tumors, cerebral pseudo tumors, or other problems.

“It must not be accompanied of fever, although in the stage of the woman´s ovulation, it raises the temperature and a crisis manages to be entail to this phenomenon. The diagnosis is eminently clinical and it insures on having discarded other complaints that simulate a pain of migraine type. It is important to study other causes to come to the prescription, that is fundamental.

“Look, when someone comes to the hospital with a pain in the breast they all think about an infarction; and in this case that occupies us it must be alarming equally even so much be demonstrated it is a product of something less worrying”.

-In a general way: some recommendation?

- The life habits must be taken care, not to smoke, not to consume alcoholic beverages, much less in excess, if they already practice these addictions to leave them under specializing orientations, and as I mentioned earlier to know yourself and to avoid the triggering effects.

-Before a headache: when does you advise to come to the doctor?

- It is always important to be checked, studied. To the beginning it does it in a sharp phase, and to never stop going to consultation if it is associated with unconsciousness and vomiting.

“Imagine, 80 per cent of the world population suffers from a headache in some moment of their lives, even, 50 per cent of recurrent way”.